Tonsillectomy used to be the most frequently performed surgery on children, but this is no longer so. Today we have a better understanding of the role of the tonsils in both health and illness, thus rates of tonsillectomy have been dramatically reduced over the last 25 years. Nevertheless, there are conditions for which tonsillectomy remains an effective treatment. The most common of these are problems of recurrent infections and obstructive sleep disturbance.
Tonsil infections can be caused by strep and other bacteria, as well as viruses. The symptoms of tonsillitis may include fever, sore throat, trouble swallowing and enlargement of the lymph glands in the neck; it is usually treated with oral antibiotics after a culture has been done. Generally, we only recommend tonsillectomy when there are frequent infections over a prolonged period of time. By maintaining rigorous criteria, we determine whether the child will most likely benefit from surgery or will outgrow the problem.
Tonsils often enlarge in young children as a response to the bacteria that routinely reside in their upper respiratory tracts. This enlargement is very common and generally of no consequence. However, in some children the tonsils get large enough to cause problems with breathing during sleep, which is obvious to most parents as snoring, gasping, and occasionally brief stops in the pattern of breathing, called apnea. Other symptoms can include irritability, daytime sleepiness, and occasionally bed wetting. Sleep studies may be recommended for children with severe apnea, who will be seen by our colleagues in pediatric neurology. For children with apnea and for children less severely affected who have obstructive sleep disturbances, tonsillectomy with adenoidectomy is often an effective treatment.
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